Welcome to Keto Sister.  Today, I am going to talk about stress.

This was a difficult experience to undergo but an easy one to write.  The challenge was that I believe in the healing power of ketogenic diets and I have experienced this power myself.  What I struggled with was accepting that I was facing something that caused me to need to tweak my own protocol away from a classic keto approach.  Once I did accept it, I was able to quickly put practices in place to reverse the effects.  It is my hope that anyone who reads this will be able to listen to their own bodies, whether that means staying ultra low carb to heal diabetes despite cravings for carbs or eating more often to heal conditions like chronic fatigue or amenorrhea despite wanting to fast for health.

Most of us are under stresses in our environments continuously, whether or not we realize it.  Stress is defined as “pressure or tension exerted on a material object” or “a state of mental or emotional strain resulting from adverse or very demanding circumstances” (Miriam-Webster, 2017).  Whether we are aware of the stresses or simply aware of the effects, most of us must hone our skills for managing the effects of these stressors.

Eating a ketogenic diet is a type of physical stress.  This is often a surprise to my clients.  We think of a low carb diet as one that alleviates many health conditions, and it can.  But you have to understand the mechanics and basic needs of the body in order to understand how ketosis effects it.  The body needs fat, amino acids and glucose.  The body cannot make amino acids, though it can break down your muscle stores if needed to obtain some (good when it breaks down cellular junk matter in a process called autophagy but not good if it breaks down your arm or leg muscle), so we need to eat some every day.  It can obtain fat from your fat stores, but those are limited and dietary fat offers important nutrient signaling to the body for hormonal production and survival, so we should eat some every day.  It can obtain glucose from your liver glycogen stores (there is glucose in the muscle but this does not come out once in there), but those stores are limited.  However, the body can also generate glucose from both fats and proteins with a process called gluconeogenesis which translates to “glucose” (gluco) “newly” (neo) “created” (genesis).  This is why even though the body needs glucose, one does not need to eat carbohydrates, the dietary source of glucose, in order to obtain it.  The act of creating glucose from fats and proteins takes additional energy—almost 10% of calories eaten are lost to this conversion which is how ketosis speeds the metabolism—and anything that takes additional energy is a stressor.

One of the problems people may encounter when beginning a ketogenic diet is a loss of energy.  When I started my ketogenic journey, I did like many are advised to do in the forums and on Facebook groups online.  I dropped my carbs overnight from over 150 grams a day to 20 grams.  I learned that the “keto flu” reaction I experienced was a result of low electrolyte levels in the body due to the loss of dietary carbs, which help the body retain hydration.  With enough added electrolytes, I was told, I could avoid the keto flu altogether.

In my case, the initial lull in energy passed quickly and I felt like a million bucks.  But nearly 18 months later, another lull in energy surfaced.  By December of this past year, I was experiencing some fatigue again, had high blood pressure, migraines and was awakening with high fasting blood glucose.  My sleep was once again disrupted, and I developed a fatigue that was only rivaled by the fatigue I experienced after the birth of my children.  Because I had been through it before, I knew exactly what was happening.

I had developed adrenal fatigue eating what was supposed to be a healthy diet.

How did this happen?  Was my diet to blame?  It took a couple months to sort out what was happening.  In my search, I developed gastrointestinal problems and wondered if my original problems that caused me to lose my gallbladder had resurfaced somehow.  Each day, I was eating a average of 2,000 calories though sometimes I ate as much as 2,500 calories.  I was walking and doing yoga a few days per week, and when I felt so inclined I also swung a kettlebell, lifted heavy, engaged in HIIT and played with my daughters.  I got sunlight.  I drank water and ate a mineral rich diet.  I was doing everything right, everything I advised my clients to do.

I was also fasting for 18-20 hours every day and limiting carbs to 30 grams in my attempt to stay “strictly keto.”  This was not something I believed was necessary for health, nor was it a protocol I recommended to my clients.  I was doing an experiment to see how far I could push a classic approach combined with fasting.  Despite the science on the effects of fasting for women (Stefani Ruper’s review is still my favorite because she sights many of the same sources I came across in my study), I was determined to prove that women could fast daily just like men can, as long as they ate enough calories.

If you have never experienced chronic fatigue, consider yourself very fortunate.  My experiences have been downright scary.  Fatigue in my body feels like the life has been sucked out of me.  It takes incredible energy to sit up, to get out of bed, and almost superhuman willpower to care for my family, to drive, to cook, to smile, to pick up my 4-year old and love my girls through the day.  Chronic fatigue feels like someone forgot to plug me in to recharge my batteries the night before, despite having slept through the night.  It feels as though no amount of sleep is enough to give me the energy to make it through basic tasks of the day.

Because I experienced fatigue after the birth of both my girls, I went into repair mode immediately when it happened this time.  I stopped exercising and limited my movements to walking and yoga.  When those proved to be too much, I stopped those too.  One day, I had to call my husband to pick my oldest daughter up from school because I did not have the energy to drive a car.  That’s when I realized I was in serious trouble.

At that moment, I went straight to the kitchen and made myself a protein shake loaded with fat and a touch of carbs.  Three hours later, I did the same thing.  Three hours, I did the same thing again.  That was the beginning of my recovery.

Is Adrenal Fatigue a “thing?”:  Managing Stress

There is some debate about whether adrenal fatigue is as common a condition as described.  This is because the adrenal glands themselves actually function just fine.  My problem was not my adrenal glands, but an overabundance of stress that my body could no longer manage.  What stresses was I facing?  I listed them to figure out what I could reverse and what I needed to manage.

I am a wife and mother.  These I would have to manage because though I’d like to get rid of them sometimes, I’m stuck with these people.  I also kind of love them.

I am a doctoral student.  I was not overly stressed and was actually doing well with my data collection.  This was another stress I would have to manage because I was not going to drop out of school.

I was exercising, but I stopped those until I felt better again (about three months).

I was managing a number of clients.  This I could change, so I decreased the number of new clients I took on until I got the next two issues figured out.  Turns out they were my primary stressors.

I was fasting every day.  Fasting presents an intense stress, and it is an even more serious stress for those who are lean.  It is also a unique stressor for women.  When we fast, we signal the body that we are in a temporary famine.  The body up-regulates a number of processes to help us obtain food again, including increasing adrenaline, norepinephrine and cortisol.  Adrenaline and norepinephrine are released in response to immediate threats.  They help you to feel more awake and alert, and in the case of chronic fasting, they give you the added energy to go get some food.  Ever wake in the middle of the night with tons of energy and find yourself unable to sleep?  This is a common response to fasting in people who are feeling the effects of the stress, but its not as good as people think it is.  Cortisol is a unique player because it takes several minutes to be released, but the body can continuously pump out cortisol as long as the ongoing stress is perceived.  I fasted every day for hours and even after I ate, I had a heightened sense of awareness and energy that would sometimes wake me from my sleep.  I now know that this was Stage 1 of three primary stress levels.  I fixed this by eating multiple small meals throughout the day.  Within a few days, my fatigue was improved by 50%.

I was eating a classic keto diet.  As I explained above, the fat adapted body is able to generate its glucose needs from protein and fats, and as long as you eat enough it has enough elements to make more than enough glucose.  However, the process of gluconeogenesis is very stressful to a body that is facing the stress of daily fasting coupled with the other stressors listed above.  Many people are able to follow a classic keto diet and also fast every day, and some of these are women.  I must say I do not know a single woman of reproductive age who is in ketosis and fasting every day and not suffering the effects of stress in some sense (loss of her menstrual cycle, elevated cortisol and belly fat or other stubborn fat areas created by cortisol, acne, moody and on edge, disrupted sleep, hair loss, brittle nails, dry skin, heart arrhythmia, cold body temperature, fatigue).  I wanted to be one, but the truth is I am not either.  Whether or not these unicorns exist is besides the point.  Forcing myself to have increased levels of stress in the name of “ketosis” was not improving my health but compromising it.  To address my stress response, I increased my daily carb consumption from 30 grams a day to 100 grams a day.  With each of my six small meals, I ate 10-15 grams of carbs from starch (potatoes, rice), legumes (kidney beans, peas and and lima beans are my favorites), sweet plants (carrots, beets) and sweet fruits (berries).  I purposefully took myself out of ketosis and this was an adjustment after being in strict ketosis for so long. My mind is not as alert or clear as it was in ketosis, but I am sleeping through the night, I feel calm and energetic, and my health markers are back in range again (see section below).

Additional support

In addition to the changes noted above, I added a few other elements to my protocol that have made all the difference in the world.

  1. Magnesium – I already supplemented with magnesium, but I changed the type to a mixture of magnesium l-threonate and magnesium glycinate. I take five times my bodyweight in milligrams (140 lbs x 5 = 700 mgs) in three separate doses through the day.
  2. Lemon balm tea – I read a study that showed lemon balm was able to simultaneously reduce the effects of stress and increase alertness without the stimulatory effects of caffeine (which is another stressor). Study participants reported feeling calmer when facing stresses and also performed better on math tests (Thorn et al., 2004).  I drink lemon balm tea every morning.
  3. Ashwaganda – This herb helps to correct cortisol levels by either boosting energy by day or calming the individual at night, and also stabilizing blood sugar, improving memory and reducing the effects on stress on brain cells (Pratte et al., 2014). It causes me to relax so I take it before bedtime.

Recovery and Returning to Classic Keto

One of the first signs that this protocol was working was that my fasting glucose dropped 30 points, from over 100 mg/dL to the 70s.  That was a nice confirmation that stress was the cause of my elevated glucose levels.  My energy improved very quickly and some early signs I had of anxiety disappeared instantly.  In making these changes, I also discovered that I no longer need to take my thyroid medication.  Apparently the “thyroid condition” I had developed was in part the result of overstressing my body.

In recent weeks since feeling well again for a couple months, I tried reducing my carbs to see how my body would react.  Each time, my symptoms return within a matter of hours.  I feel shaky, my glucose drops and then skyrockets, my blood pressure increases, I develop headaches.  It’s not a good scene.  So for the moment, I will continue to eat as soon as I wake up and continue to eat a moderate carb diet.  I am only eating three meals a day now and do not need mini meals anymore.  It turns out that eating within an hour of waking goes a long in stabilizing my blood sugar, alerting my body last night’s famine (overnight, we don’t eat and that’s technically all the fasting we need on a daily basis) is over and providing adequate energy for the morning.  Because I like breaking my fasts with a large meal, I find myself well satisfied until early afternoon.  A better strategy for those with adrenal fatigue may be to start the day with a big, healthy meal and then eating again when hungry and fasting a little before bedtime rather than beginning the day with a fast.  Only time will tell what works best for me long term, and I will share updates as I go.

Lessons on Ketosis and Fasting

What is clear to me is that compounding one stress on top of another day to day stops the body from being able to adapt to the stresses.  Would I have reacted to ketosis this way if I had not been fasting every day?  Probably not.  Will I have to eat a moderate carb diet for the rest of my life?  Probably not.  My lesson here is to pay attention to the signs the body gives that something is amiss.  Please don’t be so stubborn or dogmatic in your approach that you ignore clear signs that your body is stressed and going under.  I encounter hundreds of women in particular who ignore hunger signals and force themselves to eat less, exercise more in the name of getting skinny.  Not only are they not at their goal weight, but they are making themselves sick and ignoring those symptoms.  Here is a way to address those issues as they arise.

Are you hungry?  Eat more.

Are you not sleeping?  Increase fat and if that does not do it, increase carbs with dinner (or throughout the day).  Also, cut caffeine and stop fasting.

Are you fatigued?  Stop exercising and trying to be a superhero.  Ask for help and be willing to adjust your protocol.

Remember the goal is health and longevity, not superficial goals like fat loss or being in “true ketosis” that we think should matter.  Pay attention to your body and it will tell you if it is barely surviving or thriving.  Thanks for reading.

Miriam-Webster.com dictionary, 2017.  https://www.merriam-webster.com/dictionary/stress

Pratte, M. A., Nanavati, K. B., Young, V., & Morley, C. P. (2014). An Alternative Treatment for Anxiety: A Systematic Review of Human Trial Results Reported for the Ayurvedic Herb Ashwagandha (Withania somnifera). Journal of Alternative and Complementary Medicine20(12), 901–908. http://doi.org/10.1089/acm.2014.0177

Thorn L, Hucklebridge F, Esgate A, Evans P and Clow A (2004).  The effect of dawn simulation on the cortisol response to awakening in healthy participants.  Psychoneuroendocrinology 29 (7): 925-30.